MEDICARE: TAYLOR SCHULTZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501017946	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	432785585597	OTHER		MICHIGAN DRIVER'S LICENSE
2	5501017946	OTHER		PHYSICAL THERAPIST LICENSE

General Provider Information

NPI Number	:	1043761893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR SCHULTZ

Provider Business Mailing Address
First Line	:	3899 W FRONT ST
Second Line	:	STE 3
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-8104
Country	:	US
Telephone Number	:	248-634-4424
Fax Number	:	248-634-5995

Provider Business Practice Location Address
First Line	:	1016 N SAGINAW ST
Second Line	:
City	:	HOLLY
State	:	MI
Zip	:	48442-1379
Country	:	US
Telephone Number	:	248-634-4424
Fax Number	:	248-634-5995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	08/13/2018

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Directions to “ TAYLOR SCHULTZ ” Practice Location

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